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Cardiovascular > Peripheral arterial disease > Flashcards

Peripheral arterial disease Flashcards

1
Q

What is Peripheral Arterial Disease?

A

a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.

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2
Q

What are the risk factors of PAD?

A 
Smoking
CVD
HTN
Diabetes
Hyperlipidaemia
Older
Male
FH
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3
Q

What are the symptoms of PAD?

A

Claudication relieved by rest in calf, thigh, buttocks.

Diminished pulse

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4
Q

What would you think with gangrene, non healing ulcer and vascular bed pain?

A

Critical Emergency Ischaemia

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5
Q

What is vascular bed pain?

A

Pain in the foot at rest, relieved by hanging legs over the end of the bed

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6
Q

What are the fontaine classifications of PAD?

A
  1. Asymptomatic
    2a. Mild intermittent claudication
    2b. Mod-severe intermittent claudication
  2. Ischaemic rest pain
  3. Critical Ischaemia (decompensated PAD)
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7
Q

What are the 6 Ps of acute limb ischaemia?

A 
Pale
Pulseless
Painful
Paralysed
Parasthesia
Perishingly cold
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8
Q

What are the signs of PAD?

A 
Cold, white legs
Absent pulses
Atrophic skin (ulcers, shiny)
CRT >
Loss of hair
Thickened toenails
Dry skin between toes
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9
Q

Is critical limb ischaemia the same as acute limb ischaemia?

A

NO - acute is an emergency

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10
Q

What tests do we do for PAD?

A 
Exclude DM - Fasting Glc and HbA1c
CRP- arteritis
FBC - anaemia/polycythaemia
UEs - renal disease
Lipids - dyslipidaemia
ECG - cardiac ischaemia
ABPI
Doppler
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11
Q

What are the relevance of results in ABPI?

A

A result of 1-1.2 is normal
0.5-0.9 = PAD
<0.5 = Critical Limb Ischaemia or <50mmHg

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12
Q

With what do you finish your vascular examination?

A

ABPI
Doppler
CV exam
BM glucose

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13
Q

How do we treat PVD?

A 
Treat any risk factors:
stop smoking
control BP to <140
statins for cholesterol to reduce <5 or 25%
T2DM treatment
weight loss

Clopidogrel if not contraindicated, or aspirin 75mg OD

Manage claudication with a supervised exercise programme and Cilostazol to help claudication (100mg BD preprandial)

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14
Q

What is cilostazol?

A

Platelet inhibitor and vasodilator

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15
Q

What do we do if the lifestyle changes, supervised exercise programme, clopidogrel and cilostazel fails to help?

A

Consider revascularisation:
Duplex/doppler
MRA (angiography)

If suitable then can do:
Angioplasty and stent (Percutaneous transluminal angioplasty (PTA) )

If not suitable/failed then:
Bypass/grafting

Patient may make the decision to amputate (<3%)

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16
Q

How long do you have to save the limb in acute limb ischaemia?

A

4-6hours

17
Q

What is the amputation and death rate of acute limb ischaemia?

A

Amputation 16%

Death 22%

18
Q

What are the surgical options for Acute limb ischaemia?

A

Percutaneous thrombectomy
Angioplasty
Embolectomy
Amputation

19
Q

Which drugs do we give in acute limb ischaemia?

A

tPA - anticoagulant

Heparin

20
Q

What is vitamin K?

A

It is a coagulation therapy because vit K is a precursor for liver coagulation factors (2,7,9,10)

21
Q

Pathophysiologically, what is the difference between chronic limb ischaemia and acute limb ischaemia?

A

Chronic ischaemia is a plaque causing lumen reduction

Acute ischaemia is a ruptured plaque that has thrombosed

22
Q

Describe the order in which ā€˜Pā€™s come on in acute ischaemia, and the various management plans after each

A

Pale
Perishingly Cold
Pulseless
Painful

THIS IS REVERSIBLE and can go into surgery

4-6 hours Parasthesia w/muscle tenderness

This signifies that the clock is ticking and you need to hurry the fuck up

6-8 hours Paralysed w/numbness

This is a non-viable limb

23
Q

What is the clinical difference between acute ischaemia and acute venous disease?

A

Acute venous disease seems to be swollen, hot and tender whereas, in ischaemia, the limb is neither of these things

24
Q

What are the pathogenic causes of acute limb ischaemia?

A 
Athersclerosis + thrombosis
Embolus (cardiac/aneurysm)
Thrombosis (thrombophilia, graft occlusion, aneurysm)
Dissection
Trauma
25
Q

What is the prognosis of acute limb ischaemia?

A

Those who have chronic ischaemia have a better prognosis bc tissues are used to low O2
Proximal lesions cause more profound ischaemia
Delay of treatment

26
Q

What is the definition of claudication?

A

Aching of muscles on effort
This is predictable
Worse on hills/with load/speed
Gets better with rest

27
Q

What is rest pain?

A

Icy, burning constant aching pain in foot
Worse at night (BP reduces so perfusion decreases)
Requires opiate for release

28
Q

For how long must a patient have rest pain for before they can be diagnosed with critical limb ischaemia?

A

2 weeks with opiates

29
Q

What is the prognosis of PVD?

A

Amputation 1% IF THEY DO THINGS - it is in their hands

MI in 5 years 30%

Cardiovascular (7 decks)

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